Medical futility is commonly encountered in small animal clinical practice.

OBJECTIVE: To document veterinarians' perceptions and understanding of medical futility and determine the frequency with which medical futility occurs in small animal practice. SAMPLE: 477 veterinarians in small animal general and specialty veterinary practice. PROCEDURES: A cross-sectional study was performed with a 25-question, web-based, confidential, anonymous survey distributed through various professional veterinary specialty associations. RESULTS: Nearly all respondents (469/474 [99.0%]) believed that futile care occurs in veterinary medicine, and 42.4% (201/474) felt it occurred commonly (> 6 times/y). A similar percentage (471/475 [99.2%]) reported encountering futile care within their careers, and 85.0% (402/476) reported encountering it within the past year. A majority (293/477 [61.4%]) reported witnessing futile care occurring in both inpatient and outpatient settings. Most respondents disagreed or strongly disagreed (320/463 [69.1%]) with a statement that providing futile care is always wrong, and only 38 (8.2%) agreed or strongly agreed. Over 70% (329/464 [70.9%]) of respondents agreed that there are situations in which provision of futile care is appropriate. CLINICAL RELEVANCE: The importance of reaching a consensus definition for medical futility in veterinary medicine is evident given the frequency with which such care is being provided. Most small animal specialist veterinarians will encounter futile care, and the establishment of an ethical framework to navigate questions surrounding medical futility may help reduce moral distress.

Analysis of patient outcome and owner satisfaction with double limb amputations: 14 dogs and four cats.

OBJECTIVE: To evaluate the indications for, complications of, and surgical outcomes of dogs and cats that were treated with double limb amputations. ANIMALS: 14 dogs and 4 cats that underwent double limb amputations. PROCEDURES: Data collected retrospectively included patient-specific (species, age, weight, breed, sex, existing comorbidities) and amputation-specific (indication for amputation, full or partial limb amputation, associated complications, need for revision surgeries) variables. Owner satisfaction scores were also collected. RESULTS: The most common indication for double amputations was trauma (12/18) patients. Eleven patients had both amputations performed simultaneously. Nine patients had double partial limb amputations versus full limb amputations. Twelve patients underwent bilateral pelvic limb amputations, 4 underwent bilateral thoracic limb amputations, and 2 had 1 pelvic and 1 contralateral thoracic limb amputated. Five patients had reported complications over the course of the follow-up period, and complications for 3 patients were considered major. Revision surgery was reported for 2 animals. Owner satisfaction scores were reported as very satisfied/excellent (14/18), mildly satisfied (3/18), and strongly dissatisfied (1/18). Median time to follow-up was 450 days (range, 85 to 4,380 days). CLINICAL RELEVANCE: Double limb amputation may be a viable alternative to advanced limb-sparing procedures or humane euthanasia based on the owner satisfaction data and the relatively low rate of major complications in this study. Future studies should clarify patient selection criteria and differences in function between surgical types.

Factors associated with dehiscence and mortality rates following gastrointestinal surgery in dogs.

OBJECTIVE: To identify factors associated with dehiscence and mortality rates following gastrointestinal surgery in dogs. ANIMALS: 170 client-owned dogs that underwent gastrointestinal surgery from 2010 to 2016. PROCEDURES: Medical records of all included dogs were reviewed to collect information on preoperative (breed, sex, age, body weight, American Society of Anesthesiologists [ASA] physical status classification, emergency status, and plasma lactate concentration), intraoperative (indication for surgery, type of surgery, and whether bacterial peritonitis was identified), and postoperative (development of dehiscence and survival status at 2 weeks after surgery) factors. Preoperative and intraoperative factors were evaluated for associations among each other and with postoperative factors. RESULTS: Univariate analyses revealed that preoperative plasma lactate concentration increased with increasing ASA status, and lactate concentrations were significantly higher for nonsurvivors (mean ± SD, 4.6 ± 3.7 mmol/L) than for survivors (2.4 ± 1.7 mmol/L). Multivariate analysis controlling for age, body weight, and plasma lactate concentration revealed that dogs with an ASA status ≥ 3 were more likely to develop dehiscence after gastrointestinal surgery than were dogs with a lower ASA status (OR, 17.77; 95% confidence interval, 2.17 to 144.06). Multivariate analysis also revealed that dogs with an ASA status ≥ 3 or high lactate concentration were less likely to survive than were other dogs. CONCLUSIONS AND CLINICAL RELEVANCE: These findings regarding ASA status and preoperative plasma lactate concentration and their associations with outcome may help clinicians to determine and provide optimal perioperative care to dogs requiring gastrointestinal surgery as well as to inform owners about prognosis.

Propofol infusion-like syndrome in a dog.

An 8-year-old, spayed female Chihuahua mixed breed dog was presented for dyspnea and was subsequently mechanically ventilated. Propofol was utilized as part of the anesthetic protocol. The dog developed rhabdomyolysis, myoglobinuria, cardiac arrhythmias, liver enzyme elevation, and methemoglobinemia. Propofol was discontinued and N-acetylcysteine was administered after which the clinical signs resolved.

Syndrome s'apparentant à l'infusion de propofol chez un chien. Un chien Chihuaha mâle castré de race croisée âgé de 8 ans a été présenté pour de la dyspnée et a été subséquemment soumis à une ventilation mécanique. Le propofol a été utilisé dans le cadre du protocole anesthésique. Le chien a développé de la rhabdomyolyse, de la myoglobinurie, de l'arythmie cardiaque, une élévation des enzymes hépatiques et de la méthémoglobinémie. Le propofol a été discontinué et de la N-acétylcystéine a été administrée après la résolution des signes cliniques.(Traduit par Isabelle Vallières).

Thromboelastographic evaluation of dogs bitten by rattlesnakes native to southern California.

OBJECTIVE To validate that dogs become hypocoagulable following rattlesnake envenomation and to determine whether thromboelastographic abnormalities are correlated with envenomation severity for dogs bitten by rattlesnakes native to southern California. ANIMALS 14 dogs with observed or suspected rattlesnake envenomation (envenomated dogs) and 10 healthy control dogs. PROCEDURES For each dog, a citrate-anticoagulated blood sample underwent kaolin-activated thromboelastography. For each envenomated dog, a snakebite severity score was assigned on the basis of clinical findings, and prothrombin time, activated partial thromboplastin time, and platelet count were determined when the attending clinician deemed it necessary and owner finances allowed. RESULTS For 12 of 14 envenomated dogs, the thromboelastographically determined clot strength was below the 25th percentile for the clot strength of control dogs, which was indicative of a hypocoagulable state. No envenomated dog had thromboelastographic results indicative of a hypercoagulable state. One envenomated dog had a prolonged prothrombin time, but the activated partial thromboplastin time and all thromboelastographic variables were within the respective reference ranges for that dog. Seven of 13 envenomated dogs were thrombocytopenic (platelet count, ≤ 170,000 platelets/µL). Snakebite severity score was negatively correlated with platelet count but was not correlated with any thromboelastographic variable. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that dogs generally become hypocoagulable following rattlesnake envenomation. Thromboelastography might provide an objective measure of the coagulation status of envenomated dogs and aid in the identification of dogs that are in a hypocoagulable state and in need of antivenin treatment prior to the onset of progressive clinical signs.

The impact of surgical timing and intervention on outcome in traumatized dogs and cats.

OBJECTIVE: To review the relevant human and veterinary literature regarding the timing of surgical intervention for trauma patients and the impact on outcome. DATA SOURCES: Original research, clinical studies, and review articles with no date restrictions from both human and veterinary literature. HUMAN DATA SYNTHESIS: Despite extensive research into the ideal timing of surgical intervention for human trauma victims, debate is ongoing and views are still evolving. Prior to the 1970s, the standard of care consisted of delayed surgical treatment, as these patients were considered too ill to undergo surgery. Beginning in the 1970s, and continuing for nearly 2 decades, early definitive surgical treatment was recommended. The most recent evolution of human trauma management incorporates the concept of damage control surgery, which acknowledges the importance of early skeletal stabilization or laparotomy for reducing morbidity while attempting to avoid complications such as acute respiratory distress syndrome or multiple organ dysfunction syndrome. VETERINARY DATA SYNTHESIS: Despite a relatively large amount of literature available regarding veterinary trauma, no evidence exists to provide the clinician guidance as to the ideal timing of surgery for trauma patients. With the exception of diaphragmatic hernia, no studies were identified that attempted to evaluate this variable. CONCLUSIONS: Veterinary-specific studies are needed to evaluate the impact of surgical timing on outcome following trauma. The information that can be obtained from studies in this area can improve veterinary trauma care and may be used as models for human trauma care through translational applications.

Effect of epidural analgesia with opioids on the prevalence of urinary retention in dogs undergoing surgery for cranial cruciate ligament rupture.

OBJECTIVE: To determine whether epidural administration of opioids was associated with clinically important urinary retention in dogs undergoing elective orthopedic procedures. DESIGN: Retrospective cohort study. ANIMALS: 179 client-owned dogs undergoing elective surgery for cranial cruciate ligament rupture. PROCEDURES: Medical records of 179 dogs that underwent surgical correction for cranial cruciate rupture between January 2009 and October 2012 were reviewed; 120 received epidural administration of opioids and 59 did not. Signalment, type of procedure, administration of epidural analgesia, time to first postanesthetic urination, and number of urinations during the first 24 hours were evaluated and compared between groups. RESULTS: Administration of preservative-free morphine into the epidural space was not significantly associated with time to first urination following anesthetic recovery or the total number of urinations within the first 24 hours of anesthetic recovery. Administration of a hydromorphone bolus IV following surgery was significantly associated with urinary retention, compared with administration of either morphine boluses or fentanyl constant rate infusions following surgery. No other variables were significantly associated with urinary retention. CONCLUSIONS AND CLINICAL RELEVANCE: Administration of preservative-free morphine into the epidural space was not associated with clinically important urinary retention in dogs undergoing elective orthopedic procedures. Systemic administration of opioids may be associated with urinary retention.

Oxygen delivery.

Early recognition of failure of oxygen delivery and knowledge of how medications can alter oxygen delivery allow clinicians to institute appropriate therapies in a timely manner and can result in improved patient outcomes. Oxygen delivery can be estimated and evaluated using a variety of methods, including arterial blood gas sampling, blood lactate quantification, echocardiography, and direct cardiac output measurement. Delivery can be enhanced by manipulating the components of the oxygen delivery formula. Cardiac output, hemoglobin concentration, oxygen saturation, and oxygen tension can all be improved through therapeutic or pharmacologic intervention.

Soft palate cyst in a cat.

A 17-month-old cat presented for frequent swallowing, occasional cough and stertor. Radiographic evaluation revealed a soft tissue mass at the level of the soft palate. Oral examination revealed a soft tissue mass within the soft palate. Surgical resection was performed. Histopathology was consistent with a large developmental cyst. Following surgical management the cat has remained clinically free of signs for 2 months.